Podcast Summary: The OCD Stories – Dr Michael Greenberg: OCD as a Defense Mechanism (#489)

Guest: Dr Michael Greenberg
Host: Stuart Ralph
Date: June 8, 2025

Overview

In this episode, Stuart Ralph welcomes back Dr Michael Greenberg, a clinical psychologist renowned for his work on Rumination-Focused Exposure and Response Prevention (RF-ERP). The discussion centers on Greenberg’s recent synthesis article examining OCD from a psychoanalytic perspective, positioning OCD as a defense mechanism. Key topics include the value of integrating analytic thinking into ERP, emotional development, psychological defenses, attachment, and the implications for both clinical work and compassionate parenting.

Main Discussion Points

1. Integrating Psychoanalysis with ERP (01:50 – 06:50)

• Greenberg’s Update: Since his last appearance, he has immersed himself in psychoanalytic theory and training, participating in coursework and self-analysis.
• Clinical Approach: His private practice now integrates psychoanalytic concepts with RF-ERP, recognizing the utility and limits of both.
• Stance on Psychoanalysis and ERP:
  • "I'm not suggesting that we replace ERP with psychoanalysis. I'm suggesting that we augment ERP..." (04:08, Dr Greenberg)
• Cautions Against 'Splitting':
  • Warning against viewing treatments as either “all good” or “all bad.” Evidence-based means helpful to many, but not all. (05:04 – 06:15)

2. Emotional Development & Digesting Feelings (07:03 – 13:13)

• Infant Mentalization: Emotional understanding grows when caregivers help infants name and accept their feelings (08:43).
• Digesting Metaphor: Comparing emotional processing to food digestion—undigested feelings cause psychic symptoms.
  • "Digesting feelings is like digesting food." (11:32, Dr Greenberg)
• When Caregiving Fails: If caregivers react negatively or with misunderstanding, the child develops parts of self/feelings as “unacceptable” or unarticulated.

3. Defense Mechanisms & OCD Symptom Formation (14:49 – 22:16)

• Defense Mechanisms: We can’t simply rid ourselves of feelings—we use unconscious defenses to “hide” or disavow them from awareness.
• OCD’s Two Primary Defenses:
  • Displacement: The unacceptable feeling is transferred to a symbolic obsession (e.g., anger toward family → fear of burning the house down).
  • Undoing: Rituals/compulsions serve to “neutralize” the hidden unacceptable feeling or thought (e.g., checking the stove).
  • "What characterizes OCD is a combination of displacement... and then undoing, which is doing something to then undo it." (19:15, Dr Greenberg)
• Why Compulsions Don’t Satisfy: The compulsion never addresses the true underlying emotional issue (19:36).

4. Psychoanalysis as Restorative Experience (22:16 – 28:40)

• Making the Unconscious Conscious: Symptom relief depends on accessing, accepting, and “digesting” the hidden feeling.
• Content as Metaphor: OCD obsessional content is meaningful as metaphor, not literal evidence of desire or danger.
  • "The content of your obsession is very meaningful as a metaphor, but it’s not the thing itself." (23:37, Dr Greenberg)
• Correction in Therapy: A good analytic process recreates the experience infants need—a safe space to have all feelings.
• Layers of Defense: Psychoanalytic technique is needed to access feelings buried under defenses.
• Integration with ERP: Analytic understanding enriches ERP, making “root-level” change more possible than symptom reduction alone.

5. Clinical & Developmental Implications (32:00 – 48:33)

• Developmental Roots: Symptoms are shaped by a combination of temperament/genetics and developmental experiences. Personality and life events interact.
  • "Psychoanalysis leaves room for temperament... personality and genetics play a role." (32:24, Dr Greenberg)
• No “Perfect” Parents: All parents are imperfect; most difficulties are subtle and unintentional, not the result of ‘bad parenting’ (37:41).
  • "Nobody's perfect... That doesn’t make me a villain. That makes me a human being." (37:51, Dr Greenberg)
• Transgenerational Patterns: Family tendencies, such as criticalness or anxiety, can promote certain OCD themes, but aren't deterministic.
  • Anecdote on how his grandmother’s kitchen anxiety became his own, then affected his husband—"That's just such an easy example..." (44:12)

6. Case Example Illustrations & Theoretical Frameworks (49:32 – 55:00)

• Boundary Issues: Themes like poor sexual boundaries (not abuse, but discomfort) are sometimes found in histories of pedophilia-themed OCD—always individual, not deterministic.
• The Value of a Theoretical Framework: Psychoanalysis gives clinicians a system for “connecting the dots” in development, symptoms, and relationships.
  • "Once you have a conceptual framework, a theoretical framework for understanding how these things interact... you see all the connections among the dots..." (53:22, Dr Greenberg)

7. Evidence, Integration, and Therapist Attitudes (55:20 – 64:38)

• Difference in Research Cultures: Psychoanalysis has a rich but different research tradition and doesn’t organize around RCTs as CBT does.
  • "Psychoanalysis doesn’t care if CBT is listening to them... they’re doing their own thing." (59:28)
• Encouraging Integrative Practice: Both traditions can learn from one another; integrative therapists can better tailor care.
• Therapist Biases: Good and bad therapy, and therapists, exist in every orientation.

8. Digesting Feelings in Therapy—Shared Aim (65:07 – 66:18)

• Common Factors: No matter the modality, creating a space where feelings can be digested and accepted seems to be a key ingredient.
• Restorative Relationship: Good therapy recreates a missing experience of attuned, accepting relationship.
  • "Having been in analysis can give you a restorative, reparative relationship..." (65:58, Stuart Ralph paraphrasing Greenberg)

9. Compassionate Parenting & Human Imperfection (67:04 – 68:08)

• Normalizing Parental Mistakes: All parents bring their “stuff”; growth comes from openness and repair, not perfection.
  • "That's just about being the best we can and being open to learning and realizing we’re not perfect. And that’s okay." (67:47, Stuart Ralph)
• Modeling for Children: Demonstrating mistakes and repair helps children learn to process emotions.

Notable Quotes & Memorable Moments

• "Evidence-based means there is evidence that this treatment is somewhat helpful to many people, not that it’s all the way helpful to anyone and not that it is at all helpful to everyone." (05:04, Dr Greenberg)
• "Digesting feelings is like digesting food." (11:32, Dr Greenberg)
• "When it comes to feelings, you can't actually get rid of a feeling. How we feel about something fundamentally just is what it is." (13:13, Dr Greenberg)
• "What characterizes OCD is a combination of displacement... and undoing." (19:15, Dr Greenberg)
• "The content of your obsession is very meaningful as a metaphor, but it’s not the thing itself." (23:37, Dr Greenberg)
• "No matter how much you weed whack, unless you go for the roots and address what’s going on emotionally, you can’t... totally solve the problem." (28:40, Dr Greenberg)
• "Nobody’s perfect... That doesn’t make me a villain, that makes me a human being." (37:51, Dr Greenberg)
• "The advantage of being a specialist is... you see patterns you couldn’t see otherwise." (40:01, Dr Greenberg)
• "Psychoanalysis gives you a theoretical framework for connecting the dots..." (53:22, Dr Greenberg)
• "Case studies are missing from psychology; it’s a huge shame there aren’t tons and tons of case studies out there." (58:22, Stuart Ralph)
• "Good therapy is about being able to access, name, and digest feelings in a reparative relationship." (65:58, paraphrase)

Key Timestamps

• 01:50 – Dr Greenberg’s recent psychoanalytic immersion & practice update
• 04:08 – Augmenting ERP with psychoanalysis, not replacing it
• 08:43 – 13:13 – Infant emotional development, digestion metaphor
• 14:49 – 19:36 – Defense mechanisms in OCD: displacement & undoing explained
• 19:36 – 22:16 – Why compulsions don't satisfy; analytic approach to symptom relief
• 23:37 – Obsessional content as metaphor, not literal danger
• 28:40 – Implications of integrating analytic insight with ERP
• 32:24 – Interplay of temperament, genetics, and environment in OCD
• 37:51 – Imperfect parenting, universality of flaws
• 44:12 – Passing down anxiety: family example
• 53:22 – Conceptual frameworks: connecting the dots
• 58:22 – Dialogue on research cultures, need for case studies
• 65:58 – Digesting feelings as a universal therapy aim
• 67:47 – Compassion and permission for parental imperfection

Resources & Further Reading

• Article by Dr Michael Greenberg: [Link in show notes]
• For therapists, Dr Greenberg’s RF-ERP training integrates psychoanalytic and behavioral approaches.

Final Thoughts

This episode offers an accessible yet profound exploration of OCD as a defense mechanism, contextualizing classic ERP within a wider landscape of emotional development and human relationships. Greenberg advocates for openness, integration, and compassion—for clinicians and parents alike—reminding us that healing involves both skillful intervention and the courageous acceptance of imperfection in ourselves and others.